Spontaneous urinary extravasation: detection rate with 64-row multidetector computed tomography in patients presenting w
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ORIGINAL ARTICLE
Spontaneous urinary extravasation: detection rate with 64-row multidetector computed tomography in patients presenting with acute abdomen Dilek Kosehan & Kayihan Akin & Adem Topcu & Asli Koktener & Banu Cakir & Mehmet Teksam
Received: 28 November 2012 / Accepted: 11 March 2013 / Published online: 21 March 2013 # Am Soc Emergency Radiol 2013
Abstract The aim of this study was to detect the rate of spontaneous urinary extravasation (SUE) with computed tomography (CT) in patients presenting with acute abdomen. Seven hundred thirteen abdominal CT examinations with i.v. contrast media requested mainly from the emergency department and urology clinics for sudden onset abdominal pain, flank pain, nonspecific abdominal pain with nausea and vomiting, and renal colic between September 2007 and August 2011 were retrospectively reviewed. Only adult patients were included in the study. Three patients with SUE were detected. One had a mid-ureteral stone while the etiology for the other two patients was unknown. Two of the patients were treated conservatively; one was treated with stenting with a double-j catheter. SUE should be considered in the differential diagnosis of patients presenting with acute abdomen and perinephric–periureteral fluid collection inconsistent with stone size and who are occasionally stone free. Early and precise diagnosis of SUE plays an important D. Kosehan (*) : K. Akin : A. Topcu : A. Koktener : B. Cakir : M. Teksam Department of Radiology, Fatih University School of Medicine, Alparslan Turkes Cad. No: 57, 06510 Emek, Ankara, Turkey e-mail: [email protected] K. Akin e-mail: [email protected] A. Topcu e-mail: [email protected] A. Koktener e-mail: [email protected] B. Cakir e-mail: [email protected] M. Teksam e-mail: [email protected]
role in the management protocol of patients presenting with acute abdomen. Keywords Urinary extravasation . Spontaneous . Abdomen . Acute . Computed tomography . Multidetector
Introduction Spontaneous urinary extravasation (SUE) is an uncommon condition, referring to the leakage of urine in the perinephric space in the absence of trauma, prior instrumentation, surgery, or renal parenchymal disease [1]. It is usually associated with obstruction, secondary to impacted stone [2]. Rare causes, including pregnancy, posterior urethral valves, malignancy, aneurysms-retroperitoneal fibrosis, vasculitis, dermatomyositis, and spinal cord injuries, have been previously reported [3–9]. Clinical symptoms are nonspecific. Patients usually present with sudden onset abdominal pain with or without synchronous flank pain, and it is difficult to differentiate especially from renal colic and other causes of acute abdomen, which may cause a delay in diagnosis. Endoscopic and/or open surgical intervention may be necessary for treatment. However, there are also case reports in the literature treated successfully with conservative treatment [10]. As prognosis depends on the underlying cause, degree of renal damage, and location of rupture, early and definite
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